3D-Printed Titanium Pelvis Gets Sarcoma Patient Back on His Feet

Curt Melin was a serious soccer dad. With 5 kids ranging in age from 21 to 5, he loved to share the soccer pitch, whether practicing, coaching their teams or cheering from the sidelines. For Curt, sports – soccer, basketball, baseball and softball – were simply a part of family life.

“I love sports and think it’s great for kids, physically and socially,” he says. “Being involved in their sporting activities has always been part of my role, and I stayed in pretty good shape with coaching.”

So, when Curt began to have groin pain in 2015, he assumed it was simply a sports-related injury. But despite stretching, pain relievers and even cortisone injections, the pain increased over the course of 2 years.

Finally, imaging of Curt’s pelvis revealed a large mass, and his physician immediately referred him to Kyle Sweeney, MD, an orthopedic surgeon specializing in musculoskeletal cancers at The University of Kansas Cancer Center.

Dr. Sweeney confirmed Curt’s worst fears. The mass was sarcoma, a type of bone cancer, wrapped around the right side of Curt’s pelvis and hip joint. The only treatment involved surgically removing the tumor – and the bone along with it.

“We had a long conversation about reconstruction,” Dr. Sweeney says. “Historically, using cadaver bone or older types of implants to replace the existing pelvic bone and hip joint is wrought with complications. The safest path may have been no reconstruction at all, but Curt just wasn’t having that.”

Curt remembers that conversation and his immediate dismissal of options, including amputating his right leg, that would leave him permanently disabled. Then Dr. Sweeney went outside the box.

“He told me about something new and different, never done here before, that could possibly put me back on my feet, even though there was a high risk of infection and possible complications,” Curt, 55, recalls. “I said, ‘Yep, let’s do it.’”

The result: Curt is the first person in Kansas walking around with a custom 3D-printed titanium pelvis.

Bionic man

Onkos Surgical, founded in 2015 in Parsippany, New Jersey, creates custom bone prostheses for musculoskeletal cancer patients. Printed from titanium powder that is melded and fused by lasers, individual implants are collaboratively designed with the patient’s surgeon using detailed CT and MRI images of the patient’s natural bone. The resulting prosthesis exactly matches the original bone’s size and contours. The titanium material is durable, and there is no risk that the body will reject it.

“I had heard about this new company and process, but hadn’t worked with them before,” Dr. Sweeney says. After contacting Onkos, he worked closely with technicians to ensure Curt’s new pelvic bone would be perfect, including engineering precise surgical cutting guides to use during the procedure and creating holes for the screws that would hold Curt’s new pelvis in place. The implant serves as a metal bridge spanning the remaining left side of Curt’s natural pelvis and a standard right hip replacement.

Surgical planning was crucial, and Dr. Sweeney determined that he could attach the implant to Curt’s remaining pelvic bone in such a way that Curt would have the potential for relatively natural movement, despite the 7 pounds of hardware implanted in his pelvic region.

Howard Rosenthal, MD, orthopedic surgeon specializing in sarcoma treatment at The University of Kansas Cancer Center, joined Dr. Sweeney in the lengthy, complex surgery on May 4, 2018. The team estimated the surgery could require 10 to 16 hours in the operating room. However, the procedure went so well, it was completed in 6 hours.

Both Dr. Sweeney and Curt agree that the outcome is remarkable. “I owe the whole team at the cancer center tremendous gratitude for taking this on,” says Curt, who lives in Overland Park. From a clinical perspective, Dr. Sweeney notes that the procedure and Curt’s recovery have been a best-case scenario: “He’s pleased. I’m pleased. Curt’s cancer-free, and he has a pelvis.”

From water workouts to walking

Surgery was not the end of Curt’s journey back from cancer. In fact, it was just the beginning. He spent 4 days at The University of Kansas Hospital and 2 weeks at the Rehabilitation Hospital of Overland Park. For 3 months, while Curt’s bones, muscles and tendons healed around the new implants, he was off his feet. However, beyond knowing that Curt could not bear weight for 3 months, the protocol for recovery was uncertain since this procedure is so new. Dr. Sweeney worked with physical therapists at The University of Kansas Health System to develop a comprehensive rehabilitation plan.

Complicating Curt’s recovery, an infection developed in the surgical site after Curt’s initial stay in the hospital. Dr. Sweeney readmitted Curt to the hospital and ordered intravenous antibiotics to treat the infection. “It slowed down my rehab process by a few weeks,” Curt says. “My situation was also complicated because I have ulcerative colitis (a chronic, inflammatory bowel disease). I’ve been taking an immune-suppressing drug for my UC for a decade. The strategy going forward is to stop taking that drug so my natural immune system can kick in and help speed up the recovery process.”

Curt was eager to get back to his busy lifestyle, yet he recognized the recovery period as a time when he could unplug and reflect while he healed. Using his enforced personal time, he and his family decided to visit one of Curt’s childhood friends, Ron Russell, who lives in Jacksonville, Florida. While there, Curt discovered the benefits of hydrotherapy in his friend’s swimming pool, where he stretched and exercised several times a day, supported by the buoyancy of the warm water. When it was time to go home, Curt’s family agreed that his progress was so remarkable, he should stay and continue his pool protocol.

“I was in Florida for 6 weeks, resting, eating healthy foods and using the pool,” Curt says. “The exercises were hard, and some days I really didn’t feel like it, but my friend encouraged me every day.” When he returned home on September 10, Dr. Sweeney was amazed at Curt’s progress.

While Curt is currently cancer-free, he will be monitored for any signs of potential recurrence. However, Dr. Sweeney says Curt’s prognosis is good. “There is a pretty narrow window of indications for this type of implant since these are rare tumors, and other types of pelvic tumors can be different. But in patients like Curt who need a lifesaving surgery and are healthy enough to recover and rehabilitate, this is a very exciting new technology.”

Forward bound

Curt returned to his job in technology sales for the healthcare sector in late September. “My goal now is to walk without a hitch,” he says, noting that he continues regular hydrotherapy and physical therapy sessions. “The entire hospital and cancer center teams were phenomenal,” he adds. “They are so dedicated, and everyone I met was willing to go above and beyond.”

Curt counts his blessings every day and is eager to share his story with others. “This technology is the future,” he says of his titanium pelvis. “It’s a fantastic new option for people like me, and The University of Kansas Health System gets an A+ for being on the cutting edge.”